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Iribarne A, Alabbadi SH, Moskowitz AJ, Ailawadi G, Badhwar V, Gillinov M, Thourani VH, Allen KB, Halkos ME, Patel NC, Kramer RS, D'Alessandro D, Raymond S, Chang HL, Gupta L, Fenton KN, Taddei-Peters WC, Chu MWA, Falk V, Chikwe J, Jeffries N, Bagiella E, O'Gara PT, Gelijns AC, Egorova NN. Permanent Pacemaker Implantation and Long-Term Outcomes of Patients Undergoing Concomitant Mitral and Tricuspid Valve Surgery. J Am Coll Cardiol 2024; 83:1656-1668. [PMID: 38658105 DOI: 10.1016/j.jacc.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Tricuspid valve annuloplasty (TA) during mitral valve repair (MVr) is associated with increased risk of permanent pacemaker (PPM) implantation, but the magnitude of risk and long-term clinical consequences have not been firmly established. OBJECTIVES This study assesses the incidence rates of PPM implantation after isolated MVr and following MVr with TA as well as the associated long-term clinical consequences of PPM implantation. METHODS State-mandated hospital discharge databases of New York and California were queried for patients undergoing MVr (isolated or with concomitant TA) between 2004 and 2019. Patients were stratified by whether or not they received a PPM within 90 days of index surgery. After weighting by propensity score, survival, heart failure hospitalizations (HFHs), endocarditis, stroke, and reoperation were compared between patients with or without PPM. RESULTS A total of 32,736 patients underwent isolated MVr (n = 28,003) or MVr + TA (n = 4,733). Annual MVr + TA volumes increased throughout the study period (P < 0.001, trend), and PPM rates decreased (P < 0.001, trend). The incidence of PPM implantation <90 days after surgery was 7.7% for MVr and 14.0% for MVr + TA. In 90-day conditional landmark-weighted analyses, PPMs were associated with reduced long-term survival among MVr (HR: 1.96; 95% CI: 1.75-2.19; P < 0.001) and MVr + TA recipients (HR: 1.65; 95% CI: 1.28-2.14; P < 0.001). In both surgical groups, PPMs were also associated with an increased risk of HFH (HR: 1.56; 95% CI: 1.27-1.90; P < 0.001) and endocarditis (HR: 1.95; 95% CI: 1.52-2.51; P < 0.001), but not with stroke or reoperation. CONCLUSIONS Compared to isolated MVr, adding TA to MVr was associated with a higher risk of 90-day PPM implantation. In both surgical groups, PPM implantation was associated with an increase in mortality, HFH, and endocarditis.
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Affiliation(s)
- Alexander Iribarne
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Sundos H Alabbadi
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alan J Moskowitz
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gorav Ailawadi
- Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Keith B Allen
- Department of Cardiothoracic and Vascular Surgery, St Luke's Hospital, St Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nirav C Patel
- Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA
| | - Robert S Kramer
- Division of Cardiovascular Surgery, Maine Medical Center, Portland, Maine, USA
| | - David D'Alessandro
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samantha Raymond
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Helena L Chang
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lopa Gupta
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kathleen N Fenton
- Division of Cardiovascular Sciences, National Heart. Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Wendy C Taddei-Peters
- Division of Cardiovascular Sciences, National Heart. Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsche Herzzentrum Berlin, Berlin, Germany; Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany; German Centre for Cardiovascular Research, DZHK, Partner Site Berlin, Berlin, Germany
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Neal Jeffries
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Emilia Bagiella
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Patrick T O'Gara
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Annetine C Gelijns
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Natalia N Egorova
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Hirai T, Grantham JA, Kandzari DE, Ballard W, Brown WM, Allen KB, Kirtane AJ, Argenziano M, Yeh RW, Khabbaz K, Lombardi W, Lasala J, Kachroo P, Karmpaliotis D, Gosch KL, Salisbury AC. Percutaneous ventricular assist device for higher-risk percutaneous coronary intervention in surgically ineligible patients: Indications and outcomes from the OPTIMUM study. Catheter Cardiovasc Interv 2023; 102:814-822. [PMID: 37676058 DOI: 10.1002/ccd.30834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/25/2023] [Accepted: 08/31/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Indications and outcomes for percutaneous ventricular assist device (pVAD) use in surgically ineligible patients undergoing percutaneous coronary intervention (PCI) remain poorly characterized. AIMS We sought to describe the use and timing of pVAD and outcome in surgically ineligible patients. METHODS Among 726 patients enrolled in the prospective OPTIMUM study, clinical and health status outcomes were assessed in patients who underwent pVAD-assisted PCI and those without pVAD. RESULTS Compared with patients not receiving pVAD (N = 579), those treated with pVAD (N = 142) more likely had heart failure, lower left ventricular ejection fraction (30.7 ± 13.6 vs. 45.9 ± 15.5, p < 0.01), and higher STS 30-day predicted mortality (4.2 [2.1-8.0] vs. 3.3 [1.7-6.6], p = 0.01) and SYNTAX scores (36.1 ± 12.2, vs. 31.5 ± 12.1, p < 0.01). While the pVAD group had higher in-hospital (5.6% vs. 2.2%, p = 0.046), 30-day (9.0% vs. 4.0%, p = 0.01) and 6-month (20.4% vs. 11.7%, p < 0.01) mortality compared to patients without pVAD, this difference appeared to be largely driven by significantly higher mortality among the 20 (14%) patients with unplanned pVAD use (30% in-hospital mortality with unplanned PVAD vs. 1.6% with planned, p < 0.01; 30-day mortality, 38.1% vs. 4.5%, p < 0.01). The degree of 6-month health status improvement among survivors was similar between groups. CONCLUSION Surgically ineligible patients with pVAD-assisted PCI had more complex baseline characteristics compared with those without pVAD. Higher mortality in the pVAD group appeared to be driven by very poor outcomes by patients with unplanned, rescue pVAD.
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Affiliation(s)
- Taishi Hirai
- Division of Cardiology, University of Missouri, Columbia, Missouri, USA
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- Divison of Cardiology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | | | | | | | - Keith B Allen
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- Divison of Cardiology, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Michael Argenziano
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kamal Khabbaz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - William Lombardi
- Divsion of Cardiology, University of Washington, Seattle, Washington, USA
| | - John Lasala
- Division of Cardiology, Washington University, St. Louis, Missouri, USA
| | - Puja Kachroo
- Division of Cardiology, Washington University, St. Louis, Missouri, USA
| | | | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
- Divison of Cardiology, University of Missouri Kansas City, Kansas City, Missouri, USA
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3
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Tang GH, Spencer J, Rogers T, Grubb KJ, Gleason P, Gada H, Mahoney P, Dauerman HL, Forrest JK, Reardon MJ, Blanke P, Leipsic JA, Abdel-Wahab M, Attizzani GF, Puri R, Caskey M, Chung CJ, Chen YH, Dudek D, Allen KB, Chhatriwalla AK, Htun WW, Blackman DJ, Tarantini G, Zhingre Sanchez J, Schwartz G, Popma JJ, Sathananthan J. Feasibility of Coronary Access Following Redo-TAVR for Evolut Failure: A Computed Tomography Simulation Study. Circ Cardiovasc Interv 2023; 16:e013238. [PMID: 37988439 PMCID: PMC10653288 DOI: 10.1161/circinterventions.123.013238] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Coronary accessibility following redo-transcatheter aortic valve replacement (redo-TAVR) is increasingly important, particularly in younger low-risk patients. This study aimed to predict coronary accessibility after simulated Sapien-3 balloon-expandable valve implantation within an Evolut supra-annular, self-expanding valve using pre-TAVR computed tomography (CT) imaging. METHODS A total of 219 pre-TAVR CT scans from the Evolut Low-Risk CT substudy were analyzed. Virtual Evolut and Sapien-3 valves were sized using CT-based diameters. Two initial Evolut implant depths were analyzed, 3 and 5 mm. Coronary accessibility was evaluated for 2 Sapien-3 in Evolut implant positions: Sapien-3 outflow at Evolut node 4 and Evolut node 5. RESULTS With a 3-mm initial Evolut implant depth, suitable coronary access was predicted in 84% of patients with the Sapien-3 outflow at Evolut node 4, and in 31% of cases with the Sapien-3 outflow at Evolut node 5 (P<0.001). Coronary accessibility improved with a 5-mm Evolut implant depth: 97% at node 4 and 65% at node 5 (P<0.001). When comparing 3- to 5-mm Evolut implant depth, sinus sequestration was the lowest with Sapien-3 outflow at Evolut node 4 (13% versus 2%; P<0.001), and the highest at Evolut node 5 (61% versus 32%; P<0.001). CONCLUSIONS Coronary accessibility after Sapien-3 in Evolut redo-TAVR relates to the initial Evolut implant depth, the Sapien-3 outflow position within the Evolut, and the native annular anatomy. This CT-based quantitative analysis may provide useful information to inform and refine individualized preprocedural CT planning of the initial TAVR and guide lifetime management for future coronary access after redo-TAVR. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02701283.
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Affiliation(s)
- Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York (G.H.L.T.)
| | - Julianne Spencer
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington DC (T.R.)
| | - Kendra J. Grubb
- Division of Cardiothoracic Surgery (K.J.G.), Emory University, Atlanta, GA
- Structural Heart and Valve Center (K.J.G., P.G.), Emory University, Atlanta, GA
| | - Patrick Gleason
- Structural Heart and Valve Center (K.J.G., P.G.), Emory University, Atlanta, GA
- Division of Cardiology (P.G.), Emory University, Atlanta, GA
| | - Hemal Gada
- University of Pittsburgh Medical Center Pinnacle Health, PA (H.G.)
| | | | | | - John K. Forrest
- Division of Cardiology, Yale School of Medicine, New Haven, CT (J.K.F.)
| | | | - Philipp Blanke
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.A.L.)
| | - Jonathon A. Leipsic
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.A.L.)
| | | | - Guilherme F. Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (G.F.A.)
| | | | | | - Christine J. Chung
- Division of Cardiology, University of Washington Medical Center, Seattle (C.J.C.)
| | - Ying-Hwa Chen
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan (Y.-H.C.)
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland (D.D.)
| | - Keith B. Allen
- St. Luke’s Mid America Heart Institute, Kansas City, MO (K.B.A., A.K.C.)
| | | | | | - Daniel J. Blackman
- Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom (D.J.B.)
| | - Giuseppe Tarantini
- Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Italy (G.T.)
| | - Jorge Zhingre Sanchez
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Greta Schwartz
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Jeffrey J. Popma
- Structural Heart & Aortic, Medtronic, Mounds View, MN (J. Spencer, J.Z.S., G.S., J.J.P.)
| | - Janarthanan Sathananthan
- Center for Heart Valve Innovation, St. Paul’s Hospital, University of British Columbia, Vancouver, Canada (J. Sathananthan)
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Ubaid A, Kennedy KF, Chhatriwalla AK, Saxon JT, Hart A, Allen KB, Aberle C, Shatla I, Abumoawad A, Gunta SP, Skolnick D, Huded CP. Site Variability in Cerebral Embolic Protection for Transcatheter Aortic Valve Implantation and Association With Outcomes. Struct Heart 2023; 7:100202. [PMID: 38046858 PMCID: PMC10692348 DOI: 10.1016/j.shj.2023.100202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 12/05/2023]
Abstract
Background The effectiveness of cerebral embolic protection devices (CEPD) in mitigating stroke after transcatheter aortic valve implantation (TAVI) remains uncertain, and therefore CEPD may be utilized differently across US hospitals. This study aims to characterize the hospital-level pattern of CEPD use during TAVI in the US and its association with outcomes. Methods Patients treated with nontransapical TAVI in the 2019 Nationwide Readmissions Database were included. Hospitals were categorized as CEPD non-users and CEPD users. The following outcomes were compared: the composite of in-hospital stroke or transient ischemic attack (TIA), in-hospital ischemic stroke, death, and cost of hospitalization. Logistic regression models were used for risk adjustment of clinical outcomes. Results Of 41,822 TAVI encounters, CEPD was used in 10.6% (n = 4422). Out of 392 hospitals, 65.8% were CEPD non-user hospitals and 34.2% were CEPD users. No difference was observed between CEPD non-users and CEPD users in the risk of in-hospital stroke or TIA (adjusted odds ratio (OR) = 0.99 [0.86-1.15]), ischemic stroke (adjusted OR = 1.00 [0.85-1.18]), or in-hospital death (adjusted OR = 0.86 [0.71-1.03]). The cost of hospitalization was lower in CEPD non-users. Conclusions Two-thirds of hospitals in the US do not use CEPD for TAVI, and no significant difference was observed in neurologic outcomes among patients treated at CEPD non-user and CEPD user hospitals.
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Affiliation(s)
- Aamer Ubaid
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Kevin F. Kennedy
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Adnan K. Chhatriwalla
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - John T. Saxon
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Anthony Hart
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Keith B. Allen
- Department of Cardiothoracic Surgery, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Corinne Aberle
- Department of Cardiothoracic Surgery, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Islam Shatla
- Department of Internal Medicine, Kansas University Medical Center, Kansas City, Missouri, USA
| | - Abdelrhman Abumoawad
- Department of Vascular Medicine, Boston University Medical Center, Boston, Massachusetts, USA
| | - Satya Preetham Gunta
- Department of Internal Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - David Skolnick
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
| | - Chetan P. Huded
- Department of Cardiovascular Medicine, St Lukes Mid America Heart Institute, Kansas City, Missouri, USA
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Allen KB, Watson D, Vora AN, Mahoney P, Chhatriwalla AK, Schwartz JG, Keller A, Sodhi N, Haugan D, Caskey M. Transcarotid versus transaxillary access for transcatheter aortic valve replacement with a self-expanding valve: A propensity-matched analysis. JTCVS Tech 2023; 21:45-55. [PMID: 37854813 PMCID: PMC10580150 DOI: 10.1016/j.xjtc.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 07/22/2023] [Indexed: 10/20/2023] Open
Abstract
Transaxillary access has been the most frequently used nonfemoral access route for transcatheter aortic valve replacement (TAVR) with a self-expanding valve. Use of transcarotid TAVR is increasing; however, comparative data on these methods are limited. We compared outcomes following transcarotid or transaxillary TAVR with a self-expanding, supra-annular valve. Methods The Transcatheter Valve Therapy Registry was queried for TAVR procedures using transaxillary and transcarotid access between July 2015 and June 2021. Patients received a self-expanding Evolut R, PRO, or PRO + valve (Medtronic) and had 1-year follow-up. Thirty-day and 1-year outcomes were compared in transcarotid and transaxillary groups after 1:2 propensity score-matching. Multivariable regression models were fitted to identify predictors of key end points. Results The propensity score-matched cohort included 576 patients receiving transcarotid and 1142 receiving transaxillary access. Median procedure time (99 vs 118 minutes; P < .001) and hospital stay (2 vs 3 days; P < .001) were shorter with transcarotid versus transaxillary access. At 30 days, patients with transcarotid access had similar mortality (Kaplan-Meier estimates 3.7% vs 4.3%, P = .57) but significantly lower stroke (3.1% vs 5.9%; P = .017) and mortality or stroke (6.0% vs 8.9%; P = .033) compared with patients receiving transaxillary access. Similar differences were observed at 1 year. Transaxillary access was associated with increased risk of 30-day stroke (hazard ratio, 2.14; 95% confidence interval, 1.27-3.58) by multivariable regression analysis. Conclusions Transcarotid versus transaxillary access for TAVR using a self-expanding valve is associated with procedural benefits and significantly lower stroke and mortality or stroke at 30 days. In patients with unsuitable femoral anatomy, transcarotid access may be the preferred delivery route for self-expanding valves.
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Affiliation(s)
- Keith B. Allen
- Department of Cardiovascular/Thoracic Surgery, St Luke’s Mid America Heart Institute, Kansas City, Mo
| | - Daniel Watson
- Department of Cardiovascular/Thoracic Surgery, Riverside Methodist Hospital, Columbus, Ohio
| | - Amit N. Vora
- Department of Cardiology, University of Pittsburgh Medical Center Pinnacle Heart and Vascular Institute, Wormleysburg, Pa
| | - Paul Mahoney
- Department of Cardiology, Sentara Heart Hospital, Norfolk, Va
| | | | - Jonathan G. Schwartz
- Department of Cardiology, Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
| | - Antoine Keller
- Department of Cardiovascular/Thoracic Surgery, Ochsner Lafayette General Hospital, Lafayette, La
| | | | | | - Michael Caskey
- Department of Cardiovascular/Thoracic Surgery, Abrazo Arizona Heart Hospital, Phoenix, Ariz
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Bharadwaj SN, Liu TX, Allen KB, Mehta CK, Flaherty J, Malaisrie SC. Conformational changes during in vitro balloon fracture of internal aortic annuloplasty ring. JTCVS Tech 2023; 20:24-29. [PMID: 37555046 PMCID: PMC10405091 DOI: 10.1016/j.xjtc.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/14/2023] [Accepted: 03/18/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE HAART 300 300 (BioStable Science and Engineering, Inc) aortic annuloplasty rings restore physiologic annular geometry during aortic valve repair. Transcatheter valve-in-ring implantation is appealing for recurrent valve dysfunction but may necessitate balloon fracture of downsized annuloplasty rings. We characterized the feasibility of ring fracture and changes in ring geometry preceding fracture. METHODS The 19-mm, 21-mm, and 23-mm HAART 300 annuloplasty rings were obtained, and 23-mm, 24-mm, 25-mm, and 26-mm valvuloplasty balloons were obtained. Under continuous fluoroscopy and video recording, a 23-mm balloon was inflated within a 19-mm ring at 1 atm/s until ring fracture or balloon failure occurred. If balloon failure occurred, experiments were sequentially repeated with 1-mm upsized balloons until ring fracture occurred or no larger-sized balloons were available. RESULTS Upon balloon inflation, all rings exhibited an irreversible conformational change from an elliptical, annular geometry to a circular shape with ring posts flaring outward. A 23-mm balloon burst at 21 atm without fracturing the 19-mm ring. The 24-mm balloon fractured the 19-mm ring at 15 atm. Likewise, a 24-mm balloon ruptured at 18 atm without fracturing the 21-mm annuloplasty ring. A 25-mm balloon fractured the 21-mm ring at 18 atm. Finally, a 26-mm balloon burst at 20 atm without fracturing a 23-mm annuloplasty ring, but it did elicit the confirmational changes described. All fractures occurred along the upslope of a ring post. The exposed metal frame was visible after the 21-mm ring fracture. CONCLUSIONS Fracture of HAART 300 aortic annuloplasty rings is possible with an oversized, high-pressure balloon. However, the geometrical changes in the ring and subsequent rupture of its fabric covering may be obstacles to safe, in vivo ring fracture.
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Affiliation(s)
- Sandeep N. Bharadwaj
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Tom X. Liu
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Keith B. Allen
- St Luke's Hospital of Kansas City, Mid America Heart Institute, Kansas City, Mo
| | - Christopher K. Mehta
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - James Flaherty
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - S. Christopher Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
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7
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Meier D, Puehler T, Lutter G, Shen C, Lai A, Gill H, Akodad M, Tzimas G, Chhatriwalla A, Allen KB, Blanke P, Payne GW, Wood DA, Leipsic JA, Webb JG, Sellers SL, Sathananthan J. Bioprosthetic Valve Remodeling in Nonfracturable Surgical Valves: Impact on THV Expansion and Hydrodynamic Performance. JACC Cardiovasc Interv 2023; 16:1594-1608. [PMID: 37294230 DOI: 10.1016/j.jcin.2023.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/13/2023] [Accepted: 03/21/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND There are limited data on the effect of bioprosthetic valve remodeling (BVR) on transcatheter heart valve (THV) expansion and function following valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) in a nonfracturable surgical heart valve (SHV). OBJECTIVES This study sought to assess the impact of BVR of nonfracturable SHVs on THVs after VIV implantation. METHODS VIV TAVR was performed using 23-mm SAPIEN3 (S3, Edwards Lifesciences) or 23/26-mm Evolut Pro (Medtronic) THVs implanted in 21/23-mm Trifecta (Abbott Structural Heart) and 21/23-mm Hancock (Medtronic) SHVs with BVR performed with a noncompliant TRUE balloon (Bard Peripheral Vascular Inc). Hydrodynamic assessment was performed, and multimodality imaging including micro-computed tomography was performed before and after BVR to assess THV and SHV expansion. RESULTS BVR resulted in limited improvement of THV expansion. The largest gain in expansion was observed for the S3 in the 21-mm Trifecta with up to a 12.7% increase in expansion at the outflow of the valve. Minimal change was observed at the level of the sewing ring. The Hancock was less amenable to BVR with lower final expansion dimensions than the Trifecta. BVR also resulted in notable surgical post flaring of up to 17.6°, which was generally more marked with the S3 than with the Evolut Pro. Finally, BVR resulted in very limited improvement in hydrodynamic function. Severe pinwheeling was observed with the S3, which improved slightly but persisted despite BVR. CONCLUSIONS When performing VIV TAVR inside a Trifecta and Hancock SHV, BVR had a limited impact on THV expansion and resulted in SHV post flaring with unknown consequences on coronary obstruction risk and long-term THV function.
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Affiliation(s)
- David Meier
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Puehler
- German Centre for Cardiovascular Research, Partner Site Kiel/Hamburg/Lübeck, Kiel Germany; Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany
| | - Georg Lutter
- German Centre for Cardiovascular Research, Partner Site Kiel/Hamburg/Lübeck, Kiel Germany; Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany
| | - Carol Shen
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Althea Lai
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Hacina Gill
- Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Ramsay Santé, Institut Cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Massy, France
| | - Georgios Tzimas
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adnan Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David A Wood
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St. Paul's and Vancouver General Hospital, Vancouver, Canada; Cardiovascular Translational Laboratory, Providence Research and Centre for Heart Lung Innovation, Vancouver, Canada; Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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8
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Allen KB, Chhatriwalla AK. The 10 Commandments of Transcarotid Transcatheter Aortic Valve Replacement. Innovations (Phila) 2023; 18:217-222. [PMID: 37278401 DOI: 10.1177/15569845231174022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Keith B Allen
- Department of Cardiothoracic Surgery, St. Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Adnan K Chhatriwalla
- Department of Cardiology, St. Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, MO, USA
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Chhatriwalla AK, Allen KB, Depta JP, Rodriguez E, Thourani VH, Whisenant BK, Zahr F, Bapat V, Garcia S. Outcomes of Bioprosthetic Valve Fracture in Patients Undergoing Valve-in-Valve TAVR. JACC Cardiovasc Interv 2023; 16:530-539. [PMID: 36922038 DOI: 10.1016/j.jcin.2022.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) is increasingly used to treat degenerated surgical bioprostheses. Bioprosthetic valve fracture (BVF) has been shown to improve hemodynamic status in VIV TAVR in case series. However, the safety and efficacy of BVF are unknown. OBJECTIVES The primary objective of this study was to assess the safety and efficacy of VIV TAVR using SAPIEN 3 and SAPIEN 3 Ultra valves with or without BVF using data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry. METHODS The primary outcome was in-hospital mortality. Secondary outcomes included echocardiography-derived valve gradient and aortic valve area. Inverse probability of treatment weighting was used to adjust for baseline characteristics. RESULTS A total of 2,975 patients underwent VIV TAVR from December 15, 2020, to March 31, 2022. BVF was attempted in 619 patients (21%). In adjusted analyses, attempted BVF was associated with higher in-hospital mortality (OR: 2.51; 95% CI: 1.30-4.84) and life-threatening bleeding (OR: 2.55; 95% CI: 1.44-4.50). At discharge, VIV TAVR with attempted BVF was associated with larger aortic valve area (1.6 cm2 vs 1.4 cm2; P < 0.01) and lower mean gradient (16.3 mm Hg vs 19.2 mm Hg; P < 0.01). When BVF was compared with no BVF according to timing (before vs after transcatheter heart valve implantation), BVF after transcatheter heart valve implantation was associated with improved hemodynamic status and similar mortality. CONCLUSIONS BVF as an adjunct to VIV TAVR with the SAPIEN 3 and SAPIEN 3 Ultra valves is associated with a higher risk for in-hospital mortality and significant bleeding and modest improvements in echocardiography-derived hemodynamic status. The timing of BVF is an important determinant of safety and efficacy.
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Affiliation(s)
- Adnan K Chhatriwalla
- St. Luke's Mid America Heart Institute and the University of Missouri, Kansas City, Missouri, USA.
| | - Keith B Allen
- St. Luke's Mid America Heart Institute and the University of Missouri, Kansas City, Missouri, USA
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute/Rochester General Hospital, Rochester, New York, USA
| | | | | | | | - Firas Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | - Vinayak Bapat
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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10
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Allen KB, Chhatriwalla A, Bapat VN, Tang GHL, Grubb KJ, Setty S, Berry N, Zahr FE, Garcia S, Reardon MJ, Webb JG, Sathananthan J, Vora AN, Eisenberg R, Gada H. BIOPROSTHETIC VALVE FRACTURE IN PATIENTS UNDERGOING SELF-EXPANDING TRANSCATHETER AORTIC VALVE REPLACEMENT IN A FAILED SURGICAL VALVE: REAL-WORLD OUTCOMES FROM THE TRANSCATHETER VALVE THERAPY REGISTRY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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11
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Meier D, Payne GW, Mostaço-Guidolin LB, Bouchareb R, Rich C, Lai A, Chatfield AG, Akodad M, Salcudean H, Lutter G, Puehler T, Pibarot P, Allen KB, Chhatriwalla AK, Sondergaard L, Wood DA, Webb JG, Leipsic JA, Sathananthan J, Sellers SL. Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention: impact on valve durability and leaflet integrity. EUROINTERVENTION 2023; 18:1165-1177. [PMID: 36534495 PMCID: PMC9936256 DOI: 10.4244/eij-d-22-00644] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Bioprosthetic valve fracture (BVF) can be used to improve transcatheter heart valve (THV) haemodynamics following a valve-in-valve (ViV) intervention. However, whether BVF should be performed before or after THV deployment and the implications on durability are unknown. Aims: We sought to assess the impact of BVF timing on long-term THV durability. METHODS The impact of BVF timing was assessed using small ACURATE neo (ACn) or 23 mm SAPIEN 3 (S3) THV deployed in 21 mm Mitroflow valves compared to no-BVF controls. Valves underwent accelerated wear testing up to 200 million (M) cycles (equivalent to 5 years). At 200M cycles, THV were evaluated by hydrodynamic testing, second-harmonic generation (SHG) microscopy, scanning electron microscopy (SEM) and histology. RESULTS At 200M cycles, the regurgitant fraction (RF) and effective orifice area (EOA) for the ACn were 8.03±0.30%/1.74±0.01 cm2 (no BVF), 12.48±0.70%/1.97±0.02 cm2 (BVF before ViV) and 9.29±0.38%/2.21±0.0 cm2 (BVF after ViV), respectively. For the S3 these values were 2.63±0.51%/1.26±0.01 cm2, 2.03±0.42%/1.65±0.01 cm2, and 1.62±0.38%/2.22±0.01 cm2, respectively. Further, SHG and SEM revealed a higher degree of superficial leaflet damage when BVF was performed after ViV for the ACn and S3. However, the histological analysis revealed significantly less damage, as determined by matrix density analysis, through the entire leaflet thickness when BVF was performed after ViV with the S3 and a similar but non-significant trend with the ACn. Conclusions: BVF performed after ViV appears to offer superior long-term EOA without increased RF. Ultrastructure leaflet analysis reveals that the timing of BVF can differentially impact leaflets, with more superficial damage but greater preservation of overall leaflet structure when BVF is performed after ViV.
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Affiliation(s)
- David Meier
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Geoffrey W Payne
- University of Northern British Columbia, Prince George, BC, Canada
| | | | | | | | - Althea Lai
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Andrew G Chatfield
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Hannah Salcudean
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg, Hamburg, Germany
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg, Hamburg, Germany
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, QC, Canada
| | - Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Lars Sondergaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David A Wood
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon A Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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Salisbury AC, Grantham JA, Brown WM, Ballard WL, Allen KB, Kirtane AJ, Argenziano M, Yeh RW, Khabbaz K, Lasala J, Kachroo P, Karmpaliotis D, Moses J, Lombardi WL, Nugent K, Ali Z, Gosch KL, Spertus JA, Kandzari DE. Outcomes of Medical Therapy Plus PCI for Multivessel or Left Main CAD Ineligible for Surgery. JACC Cardiovasc Interv 2023; 16:261-273. [PMID: 36792252 DOI: 10.1016/j.jcin.2023.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/09/2022] [Accepted: 01/02/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is increasingly used to revascularize patients ineligible for CABG, but few studies describe these patients and their outcomes. OBJECTIVES This study sought to describe characteristics, utility of risk prediction, and outcomes of patients with left main or multivessel coronary artery disease ineligible for coronary bypass grafting (CABG). METHODS Patients with complex coronary artery disease ineligible for CABG were enrolled in a prospective registry of medical therapy + PCI. Angiograms were evaluated by an independent core laboratory. Observed-to-expected 30-day mortality ratios were calculated using The Society for Thoracic Surgeons (STS) and EuroSCORE (European System for Cardiac Operative Risk Evaluation) II scores, surgeon-estimated 30-day mortality, and the National Cardiovascular Data Registry (NCDR) CathPCI model. Health status was assessed at baseline, 1 month, and 6 months. RESULTS A total of 726 patients were enrolled from 22 programs. The mean SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score was 32.4 ± 12.2 before and 15.0 ± 11.7 after PCI. All-cause mortality was 5.6% at 30 days and 12.3% at 6 months. Observed-to-expected mortality ratios were 1.06 (95% CI: 0.71-1.36) with The Society for Thoracic Surgeons score, 0.99 (95% CI: 0.71-1.27) with the EuroSCORE II, 0.59 (95% CI: 0.42-0.77) using cardiac surgeons' estimates, and 4.46 (95% CI: 2.35-7.99) using the NCDR CathPCI score. Health status improved significantly from baseline to 6 months: SAQ summary score (65.9 ± 22.5 vs 86.5 ± 15.1; P < 0.0001), Kansas City Cardiomyopathy Questionnaire summary score (54.1 ± 27.2 vs 82.6 ± 19.7; P < 0.0001). CONCLUSIONS Patients ineligible for CABG who undergo PCI have complex clinical profiles and high disease burden. Following PCI, short-term mortality is considerably lower than surgeons' estimates, similar to surgical risk model predictions but is over 4-fold higher than estimated by the NCDR CathPCI model. Patients' health status improved significantly through 6 months.
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Affiliation(s)
- Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA.
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | | | | | - Keith B Allen
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Ajay J Kirtane
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Michael Argenziano
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kamal Khabbaz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - John Lasala
- Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Puja Kachroo
- Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Dimitri Karmpaliotis
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Jeffrey Moses
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | | | - Karen Nugent
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Ziad Ali
- Columbia University Irving Medical Center/NewYork-Presbyterian Hospital and the Cardiovascular Research Foundation, New York, New York, USA
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
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13
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Allen KB, Alexander JE, Liberman JN, Gabriel S. Implications of Payment for Acute Myocardial Infarctions as a 90-Day Bundled Single Episode of Care: A Cost of Illness Analysis. Pharmacoecon Open 2022; 6:799-809. [PMID: 35226305 PMCID: PMC9596673 DOI: 10.1007/s41669-022-00328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Evaluate the cost of illness associated with the 90-day period following acute myocardial infarction (AMI) and the implication of care pathway (percutaneous coronary intervention [PCI] vs medical management [MM]), in order to assess the potential financial risk incurred by providers for AMI as an episode of care. PERSPECTIVE Reimbursement payment systems for acute care episodes are shifting from 30-day to 90-day bundled payment models. Since follow-up care and readmissions beyond the early days/weeks post-AMI are common, financial risk may be transferred to providers. SETTING AMI hospitalization Centers for Medicare & Medicaid Services (CMS) standard analytical files between 10/1/2015 and 9/30/2016 were reviewed. METHODS Included patients were Medicare beneficiaries with a primary diagnosis of AMI subsequently treated with either PCI or MM. Payments were standardized to remove geographic variation and separated into reimbursements for services during the hospitalization and from discharge to 90 days post-discharge. Results were stratified by Medicare Severity Diagnosis Related Groups (MS-DRGs) individually and grouped between patients treated with MM and PCI. Risk-adjusted likelihood of utilization of post-acute nursing care and all-cause readmission was assessed by logistic regression. RESULTS A total of 96,546 patients were included in the analysis. The highest total mean payment (US$32,714) was for MS-DRG 248 (PCI with non-drug-eluting stent with major complication or comorbidity). Total payments were similar between MM and PCI patients, but MM patients incurred the majority of costs in the post-acute period after discharge, with the converse true for PCI patients. MM without catheterization was associated with a twofold increase in risk of requiring post-acute nursing care and 90-day readmission versus PCI (odds ratio [95% confidence interval]: 2.01 [1.92-2.11] and 2.17 [2.08-2.27]). Smaller hospital size, diabetes, peripheral arterial disease, prior AMI, and multivessel disease were predictors of higher healthcare utilization. CONCLUSIONS MS-DRGs associated with the lowest reimbursements (and presumably, lowest costs of inpatient care) incur the highest post-discharge expenditures. As the CMS Bundled Payment for Care Improvement and similar programs are implemented, there will be a need to account for heterogeneous post-discharge care costs. Video abstract (MP4 274659 KB).
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Affiliation(s)
- Keith B Allen
- St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | | | - Susan Gabriel
- CSL Behring, 1020 First Avenue, P.O. Box 61501, King of Prussia, PA, 19406, USA.
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Allen KB, Alexander JE, Liberman JN, Gabriel S. Correction to: Implications of Payment for Acute Myocardial Infarctions as a 90-Day Bundled Single Episode of Care: A Cost of Illness Analysis. Pharmacoecon Open 2022; 6:897. [PMID: 36165911 PMCID: PMC9596650 DOI: 10.1007/s41669-022-00367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Keith B Allen
- St. Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | | | - Susan Gabriel
- CSL Behring, 1020 First Avenue, P.O. Box 61501, King of Prussia, PA, 19406, USA.
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Salisbury AC, Kirtane AJ, Ali ZA, Grantham JA, Lombardi WL, Yeh RW, Genereux P, Allen KB, Brown WM, Nugent K, Gosch KL, Karmpaliotis D, Spertus JA, Kandzari DE. The Outcomes of Percutaneous revascularizaTIon for Management of sUrgically ineligible patients with Multivessel or left main coronary artery disease (OPTIMUM) registry: Rationale and design. Cardiovasc Revasc Med 2022; 41:83-91. [PMID: 35120846 DOI: 10.1016/j.carrev.2022.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Guidelines endorse coronary artery bypass as the preferred revascularization strategy for patients with left main and/or multivessel coronary artery disease (CAD). However, many patients are deemed excessively high risk for surgery after Heart Team evaluation. No prospective studies have examined contemporary treatment patterns, rationale for surgical decision-making, completeness of revascularization with percutaneous coronary intervention (PCI), and outcomes in this high-risk population with advanced CAD. METHODS We designed the Outcomes of Percutaneous RevascularizaTIon for Management of SUrgically Ineligible Patients with Multivessel or Left Main Coronary Artery Disease (OPTIMUM) registry, a prospective, multicenter study of patients with "surgical anatomy" determined to be at prohibitive risk for bypass surgery. The primary outcome is comparison of observed to predicted 30-day mortality, with secondary outcomes of patient-reported health status and the association between completeness of revascularization and clinical outcomes. Patient characteristics driving surgical risk determinations will be reported, and peri-operative risk will be assessed using validated scoring methods. Angiograms will be assessed by an independent core laboratory, and clinical events will be adjudicated. RESULTS Clinical outcomes assessments will include 30-day and 1-year cardiovascular events, health status at 1, 6 and 12-months, and 5-year mortality. CONCLUSIONS OPTIMUM is the first prospective, multicenter study to examine treatment strategies and outcomes among multivessel CAD patients deemed ineligible for surgical revascularization after Heart Team assessment. This registry will provide unique insights into the clinical decision-making, revascularization practices, safety, effectiveness, and health status outcomes in this high-risk population.
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Affiliation(s)
- Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America; University of Missouri-Kansas City, Kansas City, MO, United States of America.
| | - Ajay J Kirtane
- Columbia University and New York Presbyterian Hospital, New York, NY, United States of America
| | - Ziad A Ali
- Columbia University and New York Presbyterian Hospital, New York, NY, United States of America
| | - J Aaron Grantham
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America; University of Missouri-Kansas City, Kansas City, MO, United States of America
| | | | - Robert W Yeh
- Beth Israel Deaconess Medical Center, Boston, United States of America
| | | | - Keith B Allen
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America; University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - W Morris Brown
- Piedmont Heart Institute, Atlanta, GA, United States of America
| | - Karen Nugent
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America
| | - Dimitri Karmpaliotis
- Columbia University and New York Presbyterian Hospital, New York, NY, United States of America
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO, United States of America; University of Missouri-Kansas City, Kansas City, MO, United States of America
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Ranka S, Lahan S, Chhatriwalla AK, Allen KB, Chiang M, O'Neill B, Verma S, Wang DD, Lee J, Frisoli T, Eng M, Bagur R, O'Neill W, Villablanca P. Network meta-analysis comparing the short and long-term outcomes of alternative access for transcatheter aortic valve replacement. Cardiovasc Revasc Med 2021; 40:1-10. [PMID: 34972667 DOI: 10.1016/j.carrev.2021.11.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several studies have pair-wise compared access sites for transcatheter aortic valve replacement (TAVR) but pooled estimate of overall comparative efficacy and safety outcomes are not well known. We sought to compare short- and long-term outcomes following various alternative access routes for TAVR. METHODS Thirty-four studies with a pooled sample size of 32,756 patients were selected by searching PubMed and Cochrane library databases from inception through 11th June 2021 for patients undergoing TAVR via 1 of 6 different access sites: Transfemoral (TF), Transaortic (TAO), Transapical (TA), Transcarotid (TC), Transaxillary/Subclavian (TSA), and Transcaval (TCV). Data were extracted to conduct a frequentist network meta-analysis with a random-effects model using TF access as a reference group. RESULTS Compared with TF, both TAO [RR 1.91, 95% CI (1.46-2.50)] and TA access [RR 2.12, 95% CI (1.84-2.46)] were associated with an increased risk of 30-day mortality. No significant difference was observed for stroke, myocardial infarction, major bleeding, conversion to open surgery, and major adverse cardiovascular or cerebrovascular events at 30 days between different accesses. Major vascular complications were lower in TA [RR 0.43, (95% CI, 0.28-0.67)] and TC [RR 0.51, 95% CI (0.35-0.73)] access compared to TF. The 1-year mortality was higher in TAO [RR of 1.35, (95% CI, 1.01-1.81)] and TA [RR 1.44, (95% CI, 1.14-1.81)] groups. CONCLUSION Non-thoracic alternative access site utilization for TAVR implantation (TC, TSA and TCV) is associated with outcomes similar to conventional TF access. Thoracic TAVR access (TAO and TA) translates into increased short and long-term mortality.
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Affiliation(s)
- Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Shubham Lahan
- Division of Cardiovascular Prevention & Wellness, Department of Cardiology, Houston Methodist, Houston, TX, United States
| | - Adnan K Chhatriwalla
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, United States
| | - Michael Chiang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Brian O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Sadhika Verma
- Department of Family Medicine, Henry Ford Allegiance Health, Jackson, MI, United States
| | - Dee Dee Wang
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - James Lee
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Tiberio Frisoli
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Marvin Eng
- Department of Cardiology, Banner University Medical Center, Phoenix, AZ, United States
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - William O'Neill
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States
| | - Pedro Villablanca
- Department of Medicine, Division of Cardiology, Henry Ford Health System, Detroit, MI, United States.
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Allen KB. Commentary: Arkansas toothpick. JTCVS Tech 2021; 10:361. [PMID: 34977754 PMCID: PMC8691819 DOI: 10.1016/j.xjtc.2021.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Keith B. Allen
- Department of Cardiothoracic and Vascular Surgery, St Luke's Hospital, St Luke's Mid America Heart Institute, Kansas City, Mo
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18
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Allen KB, Chhatriwalla AK, Saxon JT, Huded CP, Sathananthan J, Nguyen TC, Whisenant B, Webb JG. Bioprosthetic valve fracture: a practical guide. Ann Cardiothorac Surg 2021; 10:564-570. [PMID: 34733685 DOI: 10.21037/acs-2021-tviv-25] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/18/2021] [Indexed: 11/06/2022]
Abstract
Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) is currently indicated for the treatment of failed surgical tissue valves in patients determined to be at high surgical risk for re-operative surgical valve replacement. VIV TAVR, however, often results in suboptimal expansion of the transcatheter heart valve (THV) and can result in patient-prosthesis mismatch (PPM), particularly in small surgical valves. Bioprosthetic valve fracture (BVF) and bioprosthetic valve remodeling (BVR) can facilitate VIV TAVR by optimally expanding the THV and reducing the residual transvalvular gradient by utilizing a high-pressure inflation with a non-compliant balloon to either fracture or stretch the surgical valve ring, respectively. This article, along with the supplemental video, will provide patient selection, procedural planning and technical insights for performing BVF and BVR.
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Affiliation(s)
- Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - John T Saxon
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Chetan P Huded
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Missouri, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | | | | | - John G Webb
- Centre for Cardiovascular Innovation and Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
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19
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Gabriel S, Liberman JN, Alexander JE, Allen KB. Adherence to guideline-recommended care following acute myocardial infarction: impact on clinical outcomes at 90 days and 1 year. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Guideline-recommended care is effective for secondary prevention following acute myocardial infarction (AMI); however, most pharmacotherapies take time to become efficacious and not all patients comply with treatment. It is well established that the risk of recurrent cardiovascular (CV) events is high following an AMI; however, the clinical burden of recurrent CV events among guideline-treated patients, specifically in the 90-day period post-AMI, has been relatively unexplored.
Purpose
To evaluate adherence to guideline-recommended care and determine how it impacts clinical outcomes at 90 days and 1 year post-discharge in a U.S. population.
Methods
A retrospective analysis was conducted using the IBM Health Marketscan Commercial Claims and Encounters database (July 1, 2013–June 1, 2016). In U.S. individuals with a primary diagnosis of AMI, adherence to evidence-based care was assessed in terms of claims for guideline-recommended interventions: completed physician follow-up visit within 30 days of discharge, participation in cardiac rehabilitation, and adherent (PDC ≥0.8) to beta-blocker, antiplatelet, statin, and ACE inhibitor/ARB drug classes in the year following discharge. Rates of rehospitalisation (all-cause and cardiac) and recurrent AMI events within 90 days and 1 year post-AMI were evaluated.
Results
Of the 21,977 patients included in the analysis, the majority (80.9%) visited a physician within 30 days of discharge, but few (15.4%) entered cardiac rehabilitation or were adherent to all guideline-recommended drug classes (17.1%). Even in patients fully compliant with guideline-recommended care (3.1% of the total population), event rates were high in the first year post-MI (recurrent AMI: 1.6%; cardiac rehospitalisation: 8.9%; all-cause hospitalisation 13.3%) with a large proportion of the events occurring in the first 90 days: 75%, 58.4%, and 51.1% respectively. Adherence to all drug classes significantly reduced the risk of all-cause and cardiac rehospitalisation but did not reduce the risk of recurrent AMI events (OR=1.03 [95% CI 0.73–1.46] at 90 days and OR=0.80 [95% CI 0.60–1.07] at 1 year) when compared to patients not receiving guideline-recommended pharmacotherapy.
Conclusions
Even among patients receiving guideline-recommended treatment following discharge, the risk of recurrent events remained high at both 90 days and 1 year in patients following an AMI. Novel approaches to reducing the risk of early recurrent AMI, in particular, are needed.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): CSL Behring
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Affiliation(s)
- S Gabriel
- CSL Behring, King of Prussia, United States of America
| | - J N Liberman
- Health Analytics, LLC, Columbia, United States of America
| | - J E Alexander
- Healthcare Compliance Management, LLC, Fort Worth, United States of America
| | - K B Allen
- St. Luke's Mid America Heart Institute, Kansas City, United States of America
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20
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Allen KB, Pollock G. Commentary: Just passing through. JTCVS Tech 2021; 9:100. [PMID: 34647074 PMCID: PMC8501205 DOI: 10.1016/j.xjtc.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Keith B. Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Mo
| | - Graham Pollock
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas, City School of Medicine, Kansas City, Mo
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21
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Chhatriwalla AK, Allen KB, Saxon JT, Cohen DJ, Nguyen TC, Loyalka P, Whisenant B, Yakubov SJ, Sanchez C, Sathananthan J, Stegman B, Harvey J, Garrett HE, Tseng E, Gerdisch M, Williams P, Kennedy KF, Webb J. 1-Year Outcomes following Bioprosthetic Valve Fracture to Facilitate Valve-in-Valve Transcatheter Aortic Valve Replacement. Structural Heart 2021. [DOI: 10.1080/24748706.2021.1895456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Adnan K. Chhatriwalla
- Department of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- Department of Cardiology, University of Missouri, Kansas City, Missouri, USA
| | - Keith B. Allen
- Department of Cardiothoracic Surgery, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- Department of Cardiothoracic Surgey, University of Missouri, Kansas City, Missouri, USA
| | - John T. Saxon
- Department of Cardiology, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- Department of Cardiology, University of Missouri, Kansas City, Missouri, USA
| | - David J. Cohen
- Cardiovascular Research Foundation, New York, New York, USA
- Cardiology, St. Francis Hospital, Roslyn, New York, USA
| | - Tom C. Nguyen
- Cardiothoracic Surgery, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Pranav Loyalka
- Department of Cardiology, University of Texas Medical School at Houston, Houston, Texas, USA
| | - Brian Whisenant
- Department of Cardiology, Intermountain Medical Center, Salt Lake City, Utah, USA
| | | | - Carlos Sanchez
- Department of Cardiology, Riverside Hospital, Columbus, Ohio, USA
| | - Janarthanan Sathananthan
- Department of Cardiology, Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbiaa, Canada
| | - Brian Stegman
- Department of Cardiology, Centracare Heart and Vascular Center, St Cloud, Minnesota, USA
| | - James Harvey
- Department of Cardiology, Wellspan York Hospital, York, Pennsylvania, USA
| | - H. Edward Garrett
- Department of Cardiothoracic Surgery, Baptist Memorial Hospital, Memphis, Tennessee, USA
| | - Elaine Tseng
- Department of Cardiothoracic Surgery, VA Medical Center, San Francisco, California, USA
| | - Marc Gerdisch
- Department of Cardiothoracic Surgery, Franciscan Health Heart Center, Indianapolis, Indiana, USA
| | - Paul Williams
- Department of Cardiology, James Cook University Hospital, Middlesborough, UK
| | - Kevin F. Kennedy
- Department of Biostatistics, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
| | - John Webb
- Department of Cardiology, Centre for Heart Valve Innovation, Centre for Cardiovascular Innovation, St Paul’s and Vancouver General Hospital, Vancouver, British Columbiaa, Canada
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22
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Huded CP, Allen KB, Chhatriwalla AK. Counterpoint: challenges and limitations of transcatheter aortic valve implantation for aortic regurgitation. Heart 2021; 107:1942-1945. [PMID: 33863760 DOI: 10.1136/heartjnl-2020-318682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/19/2021] [Accepted: 04/04/2021] [Indexed: 11/04/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) for isolated aortic regurgitation (AR) comprises <1.0% of all TAVI procedures performed in the USA. In this manuscript, we review the challenges, evidence and future directions of TAVI for isolated AR. There are no randomised clinical trials or mid-term data evaluating TAVI for isolated AR, and no commercially available devices are approved for this indication. Challenges in performing TAVI for isolated AR as opposed to aortic stenosis (AS) include: lack of a calcified anchoring zone for valve deployment, large and dynamic size of the aortic annulus and high stroke volume (during systole) and regurgitant volume (during diastole) across the aortic annulus during each cardiac cycle. Observational studies have shown that outcomes of TAVI for AR are worse than outcomes of TAVI for AS. However, newer generation TAVI devices may perform better than older generation devices in patients with AR. Two emerging valves (the JenaValve and the J-Valve) are designed with mechanisms to anchor in a non-calcified annulus, and these valves have shown promise for AR. Data on these devices are limited, and clinical investigation is ongoing. Randomised clinical trials are needed to establish TAVI as a safe and effective treatment for isolated AR.
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Affiliation(s)
- Chetan P Huded
- Department of Cardiology, Saint Luke's Hospital, Kansas City, Missouri, USA
| | - Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Hospital, Kansas City, Missouri, USA
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23
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Allen KB, Adams JD, Badylak SF, Garrett HE, Mouawad NJ, Oweida SW, Parikshak M, Sultan PK. Extracellular Matrix Patches for Endarterectomy Repair. Front Cardiovasc Med 2021; 8:631750. [PMID: 33644135 PMCID: PMC7904872 DOI: 10.3389/fcvm.2021.631750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
Patch repair is the preferred method for arteriotomy closure following femoral or carotid endarterectomy. Choosing among available patch options remains a clinical challenge, as current evidence suggests roughly comparable outcomes between autologous grafts and synthetic and biologic materials. Biologic patches have potential advantages over other materials, including reduced risk for infection, mitigation of an excessive foreign body response, and the potential to remodel into healthy, vascularized tissue. Here we review the use of decellularized extracellular matrix (ECM) for cardiovascular applications, particularly endarterectomy repair, and the capacity of these materials to remodel into native, site-appropriate tissues. Also presented are data from two post-market observational studies of patients undergoing iliofemoral and carotid endarterectomy patch repair as well as one histologic case report in a challenging iliofemoral endarterectomy repair, all with the use of small intestine submucosa (SIS)-ECM. In alignment with previously reported studies, high patency was maintained, and adverse event rates were comparable to previously reported rates of patch angioplasty. Histologic analysis from one case identified constructive remodeling of the SIS-ECM, consistent with the histologic characteristics of the endarterectomized vessel. These clinical and histologic results align with the biologic potential described in the academic ECM literature. To our knowledge, this is the first histologic demonstration of SIS-ECM remodeling into site-appropriate vascular tissues following endarterectomy. Together, these findings support the safety and efficacy of SIS-ECM for patch repair of femoral and carotid arteriotomy.
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Affiliation(s)
- Keith B Allen
- St. Luke's Hospital of Kansas City, St. Luke's Mid America Heart Institute, Kansas City, MO, United States
| | - Joshua D Adams
- Carilion Clinic Aortic and Endovascular Surgery, Roanoke, VA, United States
| | - Stephen F Badylak
- Department of Bioengineering, Department of Surgery, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - H Edward Garrett
- Cardiovascular Surgery Clinic, University of Tennessee, Memphis, Memphis, TN, United States
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24
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Allen KB, Chhatriwalla AK, Saxon J, Hermiller J, Heimansohn D, Moainie S, McKay RG, Cheema M, Jones B, Hodson RW, Korngold E, Kirker E. Reply: Transcarotid trumps transapical/direct aortic access for transcatheter aortic valve replacement—It's a no brainer! J Thorac Cardiovasc Surg 2021; 164:e84-e86. [DOI: 10.1016/j.jtcvs.2021.01.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
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Allen KB, Chhatriwalla AK, Saxon JT, Sathananthan J, Dvir D, Webb JG. Bioprosthetic valve fracture to facilitate valve-in-valve transcatheter aortic valve repair. Ann Cardiothorac Surg 2020; 9:528-530. [PMID: 33312917 DOI: 10.21037/acs-2020-av-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - John T Saxon
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Danny Dvir
- Shaare Zedek Medical Centre, Hebrew University, Jerusalem, Israel.,University of Washington, Seattle, WA, USA
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
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26
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Kirker E, Korngold E, Hodson RW, Jones BM, McKay R, Cheema M, Heimansohn D, Moainie S, Hermiller J, Chatriwalla A, Saxon J, Allen KB. Transcarotid Versus Subclavian/Axillary Access for Transcatheter Aortic Valve Replacement With SAPIEN 3. Ann Thorac Surg 2020; 110:1892-1897. [DOI: 10.1016/j.athoracsur.2020.05.141] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
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Bhardwaj B, Cohen DJ, Vemulapalli S, Kosinski AS, Xiang Q, Li Z, Allen KB, Kapadia S, Aggarwal K, Sorajja P, Chhatriwalla AK. Outcomes of transcatheter aortic valve replacement for patients with severe aortic stenosis and concomitant aortic insufficiency: Insights from the TVT Registry. Am Heart J 2020; 228:57-64. [PMID: 32828047 DOI: 10.1016/j.ahj.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022]
Abstract
AIMS Data regarding outcomes for patients with severe aortic stenosis (AS) with concomitant aortic insufficiency (AI), undergoing transcatheter aortic valve replacement (TAVR) are limited. This study aimed to analyze the prevalence of severe AS with concomitant AI among patients undergoing TAVR and outcomes of TAVR in this patient group. METHODS AND RESULTS Using data from the STS/ACC-TVT Registry, we identified patients with severe AS with or without concomitant AI who underwent TAVR between 2011 and 2016. Patients were categorized based on the severity of pre-procedural AI. Multivariable proportional hazards regression models were used to examine all-cause mortality and heart failure (HF) hospitalization at 1-year. Among 54,535 patients undergoing TAVR, 42,568 (78.1%) had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001). CONCLUSIONS Severe AS with concomitant AI is common among patients undergoing TAVR, and is associated with lower 1 year mortality and HF hospitalization. Future studies are warranted to better understand the mechanisms underlying this benefit. SHORT ABSTRACT In this nationally representative analysis from the United States, 78.1% of patients undergoing TAVR had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001).
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28
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Sathananthan J, Fraser R, Hatoum H, Barlow AM, Stanová V, Allen KB, Chhatriwalla AK, Rieu R, Pibarot P, Dasi LP, Søndergaard L, Wood DA, Webb JG. A bench test study of bioprosthetic valve fracture performed before versus after transcatheter valve-in-valve intervention. EUROINTERVENTION 2020; 15:1409-1416. [DOI: 10.4244/eij-d-19-00939] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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29
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Sathananthan J, Sellers S, Barlow AM, Stanová V, Fraser R, Toggweiler S, Allen KB, Chhatriwalla A, Murdoch DJ, Hensey M, Lau K, Alkhodair A, Dvir D, Asgar AW, Cheung A, Blanke P, Ye J, Rieu R, Pibarot P, Wood D, Leipsic J, Webb JG. Valve-in-Valve Transcatheter Aortic Valve Replacement and Bioprosthetic Valve Fracture Comparing Different Transcatheter Heart Valve Designs: An Ex Vivo Bench Study. JACC Cardiovasc Interv 2019; 12:65-75. [PMID: 30621980 DOI: 10.1016/j.jcin.2018.10.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/04/2018] [Accepted: 10/23/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors assessed the effect of valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) followed by bioprosthetic valve fracture (BVF), testing different transcatheter heart valve (THV) designs in an ex vivo bench study. BACKGROUND Bioprosthetic valve fracture can be performed to improve residual transvalvular gradients following VIV TAVR. METHODS The authors evaluated VIV TAVR and BVF with the SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) and ACURATE neo (Boston Scientific Corporation, Natick, Massachusetts) THVs. A 20-mm and 23-mm S3 were deployed in a 19-mm and 21-mm Mitroflow (Sorin Group USA, Arvada, Colorado), respectively. A small ACURATE neo was deployed in both sizes of Mitroflow tested. VIV TAVR samples underwent multimodality imaging, and hydrodynamic evaluation before and after BVF. RESULTS A high implantation was required to enable full expansion of the upper crown of the ACURATE neo and allow optimal leaflet function. Marked underexpansion of the lower crown of the THV within the surgical valve was also observed. Before BVF, VIV TAVR in the 19-mm Mitroflow had high transvalvular gradients using either THV design (22.0 mm Hg S3, and 19.1 mm Hg ACURATE neo). After BVF, gradients improved and were similar for both THVs (14.2 mm Hg S3, and 13.8 mm Hg ACURATE neo). The effective orifice area increased with BVF from 1.2 to 1.6 cm2 with the S3 and from 1.4 to 1.6 cm2 with the ACURATE neo. Before BVF, VIV TAVR with the ACURATE neo in the 21-mm Mitroflow had lower gradients compared with S3 (11.3 mm Hg vs. 16 mm Hg). However, after BVF valve gradients were similar for both THVs (8.4 mm Hg ACURATE neo vs. 7.8 mm Hg S3). The effective orifice area increased from 1.5 to 2.1 cm2 with the S3 and from 1.8 to 2.2 cm2 with the ACURATE neo. CONCLUSIONS BVF performed after VIV TAVR results in improved residual gradients. Following BVF, residual gradients were similar irrespective of THV design. Use of a small ACURATE neo for VIV TAVR in small (≤21 mm) surgical valves may be associated with challenges in achieving optimum THV position and expansion. BVF could be considered in selected clinical cases.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron M Barlow
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada
| | | | - Rob Fraser
- ViVitro Labs Inc., Victoria, British Columbia, Canada
| | | | - Keith B Allen
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Adnan Chhatriwalla
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Dale J Murdoch
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; University of Queensland, Brisbane, Australia
| | - Mark Hensey
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Lau
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah Alkhodair
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danny Dvir
- University of Washington, Seattle, Washington
| | | | - Anson Cheung
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Régis Rieu
- Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, Marseille, France
| | | | - David Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Allen KB, Brovman EY, Chhatriwalla AK, Greco KJ, Rao N, Kumar A, Urman RD. Opioid-Related Adverse Events: Incidence and Impact in Patients Undergoing Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2019; 24:219-226. [DOI: 10.1177/1089253219888658] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Purpose. Opioid-related adverse drug events (ORADEs) increase patient length of stay (LOS) and health care costs. However, ORADE rates may be underreported. This study attempts to understand the degree to which ORADEs are underreported in Medicare patients undergoing cardiac surgery. Materials and Methods. The Center for Medicare and Medicaid Services administrative claims database was used to identify ORADEs in 110 158 Medicare beneficiaries who underwent cardiac valve (n = 50 525) or coronary bypass (n = 59 633) surgery between April 2016 and March 2017. The International Classification of Disease (ICD)-10 codes specifically linked to ORADEs were used to identify an actual ORADE rate, while additional ICD codes, clinically associated with butas not specific to adverse drug events were analyzed as potential ORADEs. Length of stay (LOS) and hospital daily revenue were analyzed among patients with or without a potential ORADE. Results. Among patients undergoing valve or bypass surgery, the documented ORADE rate was 0.7% (743/110 158). However, potential ORADEs may have occurred in up to 32.4% (35 658/110 158) of patients. In patients with a potential ORADE, mean LOS was longer (11.4 vs 8.2 days; P < .0001) and mean Medicare revenue/day was lower ($4016 vs $4412; P < .0001). The mean net difference in revenue/day between patients with and without an ORADE varied between $231 and $1145, depending on the Diagnosis-Related Group analyzed. Conclusions. ORADEs are likely underreported following cardiac surgery. ORADEs can be associated with increased LOS and decreased hospital revenue. Understanding the incidence and economic impact of ORADEs may expedite changes to postoperative pain management. Adopting multimodal pain management strategies that reduce exposure to opioids may improve outcomes by reducing complications, side effects, and health care costs.
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Affiliation(s)
- Keith B. Allen
- Saint Luke’s Hospital, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Ethan Y. Brovman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Adnan K. Chhatriwalla
- Saint Luke’s Hospital, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | | | | | | | - Richard D. Urman
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Allen KB, Chhatriwalla AK, Saxon JT, Cohen DJ, Nguyen TC, Webb J, Loyalka P, Bavry AA, Rovin JD, Whisenant B, Dvir D, Kennedy KF, Thourani V, Lee R, Aggarwal S, Baron S, Hart A, Davis JR, Borkon AM, Janarthanan S, Beaver T, Karimi A, Gory D, Lin L, Spriggs D, Ofenloch J, Dhoble A, Loyalka P, Hummel B, Russo M, Haik B, Lim M, Babaliaros V, Greenbaum A, O'Neill W, Karha J, Park D, Garrett E, Pak A, Hawa Z, Mitchell J, Unbehaun A, Tandar A, Yadav P, Ricci J, Yeung A. Bioprosthetic valve fracture: Technical insights from a multicenter study. J Thorac Cardiovasc Surg 2019; 158:1317-1328.e1. [DOI: 10.1016/j.jtcvs.2019.01.073] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 01/09/2019] [Accepted: 01/21/2019] [Indexed: 11/26/2022]
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Sathananthan J, Hensey M, Sellers S, Barlow AM, Chhatriwalla AK, Allen KB, Cheung A, Søndergaard L, Blanke P, Ye J, Leipsic J, Wood D, Webb J. Performance of the TRUE dilatation balloon valvuloplasty catheter beyond rated burst pressure: A bench study. Catheter Cardiovasc Interv 2019; 96:E187-E195. [PMID: 31566873 DOI: 10.1002/ccd.28503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/05/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We undertook an independent bench test assessing the performance of the TRUE dilatation (TD) balloon valvuloplasty catheter (Bard Vascular Inc., Tempe, AZ) beyond its rated burst pressure (RBP). BACKGROUND The TD balloon has a RBP of six atmospheres (atm), and its performance beyond this RBP is poorly understood. Techniques such as bioprosthetic valve fracture require inflation pressures beyond manufacturer recommendations. METHODS A 20, 22, 24, 26, and 28 mm TD balloon were inflated to increasing pressures in increments of 3 atm until balloon failure. Measurements were performed at the proximal, middle, and distal balloon segments with scientific digital calipers. Z-MED balloons (Braun Interventional Systems Inc., Bethlehem, PA) were used as a comparator. RESULTS The mean diameter at the middle of the 20, 22, 24, 26, and 28 mm TD balloon at nominal pressure (3 atm) was 20.02 ± 0.09, 21.77 ± 0.07, 23.9 ± 0.06, 25.82 ± 0.08, and 27.62 ± 0.08 mm, respectively. The maximal mean diameter at the middle of the 20, 22, 24, 26, and 28 mm TD balloon was 20.39 ± 0.03 mm (15 atm), 22.35 ± 0.03 mm (15 atm), 24.55 ± 0.02 mm (15 atm), 26.48 ± 0.02 mm (12 atm), and 28.39 ± 0.03 mm (12 atm), respectively. The 20/22/24 and 26/28 mm balloon failed when inflated beyond 15 atm and 12 atm, respectively. Failure was due to either leakage or longitudinal balloon rupture. TD balloons were more likely to maintain dimensions similar to their labeled size and less likely to fail at higher pressures as compared to Z-MED balloons. CONCLUSION The TD balloon catheter maintains a similar diameter to its labeled size, when inflated beyond its RBP. When inflated beyond 12 atm, the TD balloon can fail due to either leakage or rupture. This has implications for percutaneous structural heart interventions.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Mark Hensey
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Stephanie Sellers
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Aaron M Barlow
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Adnan K Chhatriwalla
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Keith B Allen
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Anson Cheung
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Jonathan Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - David Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - John Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, Canada
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Allen KB, Chhatriwalla AK, Cohen D, Saxon J, Hawa Z, Kennedy KF, Aggarwal S, Davis R, Pak A, Borkon AM. Transcarotid Versus Transapical and Transaortic Access for Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2019; 108:715-722. [DOI: 10.1016/j.athoracsur.2019.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/18/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
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Allen KB, Vamanan K, Alsop S, Chhatriwalla A, Saxon J, Aggarwal S, Davis JR, Borkon AM. PC012. Carotid Access to Deliver Large Endovascular Devices in Patients With Inadequate Iliofemoral Access. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Saxon JT, Allen KB, Cohen DJ, Whisenant B, Ricci J, Barb I, Gafoor S, Harvey J, Dvir D, Chhatriwalla AK. Complications of Bioprosthetic Valve Fracture as an Adjunct to Valve-in-Valve TAVR. Structural Heart 2019. [DOI: 10.1080/24748706.2019.1578446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- John T. Saxon
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri–Kansas City, Kansas City, Missouri, USA
| | - Keith B. Allen
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri–Kansas City, Kansas City, Missouri, USA
| | - David J. Cohen
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri–Kansas City, Kansas City, Missouri, USA
| | | | - Jason Ricci
- McLaren Northern Michigan Hospital, Petoskey, Michigan, USA
| | - Ilie Barb
- Cardiac and Vascular Institute, Gainesville, Florida, USA
| | - Sameer Gafoor
- Swedish Medical Center, Seattle, Washington, USA
- Cardiovascular Center–Frankfurt, Frankfurt, Germany
| | | | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Adnan K. Chhatriwalla
- Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, USA
- University of Missouri–Kansas City, Kansas City, Missouri, USA
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Allen KB, Mahoney A, Aggarwal S, Davis JR, Thompson E, Pak AF, Heimes J, Michael Borkon A. Transmyocardial revascularization (TMR): current status and future directions. Indian J Thorac Cardiovasc Surg 2018; 34:330-339. [PMID: 33060956 DOI: 10.1007/s12055-018-0702-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/07/2018] [Accepted: 07/13/2018] [Indexed: 01/22/2023] Open
Abstract
Purpose Cardiac surgeons are increasingly faced with a more complex patient who has developed a pattern of diffuse coronary artery disease (CAD), which is refractory to medical, percutaneous, and surgical interventions. This paper will review the clinical science surrounding transmyocardial revascularization (TMR) with an emphasis on the results from randomized controlled trials. Methods Randomized controlled trials which evaluated TMR used as sole therapy and when combined with coronary artery bypass grafting were reviewed. Pertinent basic science papers exploring TMR's possible mechanism of action along with future directions, including the synergism between TMR and cell-based therapies were reviewed. Results Two laser-based systems have been approved by the United States Food and Drug Administration (FDA) to deliver laser therapy to targeted areas of the left ventricle (LV) that cannot be revascularized using conventional methods: the holmium:yttrium-aluminum-garnet (Ho:YAG) laser system (CryoLife, Inc., Kennesaw, GA) and the carbon dioxide (CO2) Heart Laser System (Novadaq Technologies Inc., (Mississauga, Canada). TMR can be performed either as a stand-alone procedure (sole therapy) or in conjunction with coronary artery bypass graft (CABG) surgery in patients who would be incompletely revascularized by CABG alone. Societal practice guidelines have been established and are supportive of using TMR in the difficult population of patients with diffuse CAD. Conclusions Patients with diffuse CAD have increased operative and long-term cardiac risks predicted by incomplete revascularization. The documented operative and long-term benefits associated with sole therapy and adjunctive TMR in randomized trials supports TMR's increased use in this difficult patient population.
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Affiliation(s)
- Keith B Allen
- Saint Luke's Mid America Heart Institute, 4320 Wornall Rd, Medical Plaza II, Suite 50, Kansas City, MO 64111 USA
| | | | - Sanjeev Aggarwal
- Saint Luke's Mid America Heart Institute, 4320 Wornall Rd, Medical Plaza II, Suite 50, Kansas City, MO 64111 USA
| | - John Russell Davis
- Saint Luke's Mid America Heart Institute, 4320 Wornall Rd, Medical Plaza II, Suite 50, Kansas City, MO 64111 USA
| | - Eric Thompson
- Saint Luke's Mid America Heart Institute, 4320 Wornall Rd, Medical Plaza II, Suite 50, Kansas City, MO 64111 USA
| | - Alex F Pak
- Saint Luke's Mid America Heart Institute, 4320 Wornall Rd, Medical Plaza II, Suite 50, Kansas City, MO 64111 USA
| | - Jessica Heimes
- Saint Luke's Mid America Heart Institute, 4320 Wornall Rd, Medical Plaza II, Suite 50, Kansas City, MO 64111 USA
| | - A Michael Borkon
- Saint Luke's Mid America Heart Institute, 4320 Wornall Rd, Medical Plaza II, Suite 50, Kansas City, MO 64111 USA
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Allen KB, Icke KJ, Thourani VH, Naka Y, Grubb KJ, Grehan J, Patel N, Guy TS, Landolfo K, Gerdisch M, Bonnell M. Sternotomy closure using rigid plate fixation: a paradigm shift from wire cerclage. Ann Cardiothorac Surg 2018; 7:611-620. [PMID: 30505745 DOI: 10.21037/acs.2018.06.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Rigid plate fixation (RPF) is the cornerstone in managing fractures and osteotomies except for sternotomy, where most cardiac surgeons continue to use wire cerclage (WC). Results of a multicenter randomized trial evaluating sternal healing, sternal complications, patient reported outcome measures (PROMs), and costs after sternotomy closure with RPF or WC are summarized here. Methods Twelve US centers randomized 236 patients to either RPF (n=116) or WC (n=120). The primary endpoint, sternal healing at 6 months, was evaluated by a core laboratory using computed tomography and a validated 6-point scale (greater scores represent greater healing). Secondary endpoints assessed through 6 months included sternal complications and PROMs. Costs from the time of sternal closure through 90 days and 6 months were analyzed by a health economic core laboratory. Results RPF compared to WC resulted in better sternal healing scores at 3 (2.6±1.1 vs. 1.8±1.0; P<0.0001) and 6 months (3.8±1.0 vs. 3.3±1.1; P=0.0007) and higher sternal union rates at 3 [41% (42/103) vs. 16% (16/102); P<0.0001] and 6 months [80% (81/101) vs. 67% (67/100); P=0.03]. There were fewer sternal complications with RPF through 6 months [0% (0/116) vs. 5% (6/120); P=0.03] and a trend towards fewer sternal wound infections [0% (0/116) vs. 4.2% (5/120); P=0.06]. All PROMs including sternal pain, upper extremity function (UEF), and quality-of-life scores were numerically better in RPF patients compared to WC patients at all follow-up time points. Although RPF was associated with a trend toward higher index hospitalization costs, a trend towards lower follow-up costs resulted in total costs that were $1,888 less at 90 days in RPF patients compared to WC patients (95% CI: -$8,889 to $4,273; P=0.52) and $1,646 less at 6 months (95% CI: -$9,127 to $4,706; P=0.61). Conclusions Sternotomy closure with RPF resulted in significantly better sternal healing, fewer sternal complications, improved PROMs and was cost neutral through 90 days and 6 months compared to WC.
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Affiliation(s)
- Keith B Allen
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | | | | | | | | | | | | | | | - Marc Gerdisch
- Franciscan St. Francis Health, Indianapolis, IN, USA
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Allen KB, Thourani VH, Naka Y. The right wiring configuration for sternal closure: Science or mythology? J Thorac Cardiovasc Surg 2017; 154:2004-2005. [PMID: 29132894 DOI: 10.1016/j.jtcvs.2017.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/26/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Vinod H Thourani
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute, Washington Hospital Center, Washington, DC
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
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Allen KB, Yuh DD, Schwartz SB, Lange RA, Hopkins R, Bauer K, Marders JA, Delgado Donayre J, Milligan N, Wentz C. Nontuberculous Mycobacterium Infections Associated With Heater-Cooler Devices. Ann Thorac Surg 2017; 104:1237-1242. [DOI: 10.1016/j.athoracsur.2017.04.067] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/21/2017] [Accepted: 04/04/2017] [Indexed: 11/27/2022]
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Allen KB, Thourani VH, Naka Y. Sternal healing comes from stable beginnings. J Thorac Cardiovasc Surg 2017; 154:943-944. [PMID: 28826161 DOI: 10.1016/j.jtcvs.2017.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 05/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Keith B Allen
- Department of Cardiothoracic Surgery, Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Yoshifumi Naka
- Division of Cardiothoracic Surgery, Department of Surgery, Columbia University Medical Center, New York, NY
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Chhatriwalla AK, Allen KB, Saxon JT, Cohen DJ, Aggarwal S, Hart AJ, Baron SJ, Dvir D, Borkon AM. Bioprosthetic Valve Fracture Improves the Hemodynamic Results of Valve-in-Valve Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005216. [DOI: 10.1161/circinterventions.117.005216] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/05/2017] [Indexed: 11/16/2022]
Abstract
Background—
Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) may be less effective in small surgical valves because of patient/prosthesis mismatch. Bioprosthetic valve fracture (BVF) using a high-pressure balloon can be performed to facilitate VIV TAVR.
Methods and Results—
We report data from 20 consecutive clinical cases in which BVF was successfully performed before or after VIV TAVR by inflation of a high-pressure balloon positioned across the valve ring during rapid ventricular pacing. Hemodynamic measurements and calculation of the valve effective orifice area were performed at baseline, immediately after VIV TAVR, and after BVF. BVF was successfully performed in 20 patients undergoing VIV TAVR with balloon-expandable (n=8) or self-expanding (n=12) transcatheter valves in Mitroflow, Carpentier-Edwards Perimount, Magna and Magna Ease, Biocor Epic and Biocor Epic Supra, and Mosaic surgical valves. Successful fracture was noted fluoroscopically when the waist of the balloon released and by a sudden drop in inflation pressure, often accompanied by an audible snap. BVF resulted in a reduction in the mean transvalvular gradient (from 20.5±7.4 to 6.7±3.7 mm Hg,
P
<0.001) and an increase in valve effective orifice area (from 1.0±0.4 to 1.8±0.6 cm
2
,
P
<0.001). No procedural complications were reported.
Conclusions—
BVF can be performed safely in small surgical valves to facilitate VIV TAVR with either balloon-expandable or self-expanding transcatheter valves and results in reduced residual transvalvular gradients and increased valve effective orifice area.
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Affiliation(s)
- Adnan K. Chhatriwalla
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - Keith B. Allen
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - John T. Saxon
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - David J. Cohen
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - Sanjeev Aggarwal
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - Anthony J. Hart
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - Suzanne J. Baron
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - Danny Dvir
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
| | - A. Michael Borkon
- From the Saint Luke’s Mid America Heart Institute, Kansas City, MO (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); University of Missouri, Kansas City (A.K.C., K.B.A., J.T.S., D.J.C., S.A., A.J.H., S.J.B., A.M.B.); and St. Paul’s Hospital, British Columbia, Canada (D.D.)
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Baron SJ, Arnold SV, Herrmann HC, Holmes DR, Szeto WY, Allen KB, Chhatriwalla AK, Vemulapali S, O'Brien S, Dai D, Cohen DJ. Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2017; 67:2349-2358. [PMID: 27199058 DOI: 10.1016/j.jacc.2016.03.514] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), studies have suggested that reduced left ventricular (LV) ejection fraction (LVEF) and low aortic valve gradient (AVG) are associated with worse long-term outcomes. Because these conditions commonly coexist, the extent to which they are independently associated with outcomes after TAVR is unknown. OBJECTIVES The purpose of this study was to evaluate the impact of LVEF and AVG on clinical outcomes after TAVR and to determine whether the effect of AVG on outcomes is modified by LVEF. METHODS Using data from 11,292 patients who underwent TAVR as part of the Transcatheter Valve Therapies Registry, we examined rates of 1-year mortality and recurrent heart failure in patients with varying levels of LV dysfunction (LVEF <30% vs. 30% to 50% vs. >50%) and AVG (<40 mm Hg vs. ≥40 mm Hg). Multivariable models were used to estimate the independent effect of AVG and LVEF on outcomes. RESULTS During the first year of follow-up after TAVR, patients with LV dysfunction and low AVG had higher rates of death and recurrent heart failure. After adjustment for other clinical factors, only low AVG was associated with higher mortality (hazard ratio: 1.21; 95% confidence interval: 1.11 to 1.32; p < 0.001) and higher rates of heart failure (hazard ratio: 1.52; 95% confidence interval: 1.36 to 1.69; p <0.001), whereas the effect of LVEF was no longer significant. There was no evidence of effect modification between AVG and LVEF with respect to either endpoint. CONCLUSIONS In this series of real-world patients undergoing TAVR, low AVG, but not LV dysfunction, was associated with higher rates of mortality and recurrent heart failure. Although these findings suggest that AVG should be considered when evaluating the risks and benefits of TAVR for individual patients, neither severe LV dysfunction nor low AVG alone or in combination provide sufficient prognostic discrimination to preclude treatment with TAVR.
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Affiliation(s)
- Suzanne J Baron
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Howard C Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Philadelphia
| | | | - Wilson Y Szeto
- Hospital of the University of Pennsylvania, Philadelphia, Philadelphia
| | - Keith B Allen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Sean O'Brien
- Duke Clinical Research Institute, Durham, North Carolina
| | - Dadi Dai
- Duke Clinical Research Institute, Durham, North Carolina
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
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Allen KB, Vamanan K, Borkon AM, Aggarwal S, Hawa Z, Davis JR, Pak A. PC110 Carotid Access to Deliver Large Endovascular Devices in Patients With Inadequate Iliofemoral Access. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Allen KB, Thourani VH, Naka Y, Grubb KJ, Grehan J, Patel N, Guy TS, Landolfo K, Gerdisch M, Bonnell M, Cohen DJ. Randomized, multicenter trial comparing sternotomy closure with rigid plate fixation to wire cerclage. J Thorac Cardiovasc Surg 2017; 153:888-896.e1. [DOI: 10.1016/j.jtcvs.2016.10.093] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/11/2016] [Accepted: 10/12/2016] [Indexed: 11/26/2022]
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Abstract
Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) has been established as a safe and effective means of treating failed surgical bioprosthetic valves (BPVs) in patients at high risk for complications related to reoperation. Patients who undergo VIV TAVR are at risk of patient-prosthesis mismatch, as the transcatheter heart valve (THV) is implanted within the ring of the existing BPV, limiting full expansion and reducing the maximum achievable effective orifice area of the THV. Importantly, patient-prosthesis mismatch and high residual transvalvular gradients are associated with reduced survival following VIV TAVR. Bioprosthetic valve fracture (BVF) is as a novel technique to address this problem. During BPV, a non-compliant valvuloplasty balloon is positioned within the BPV frame, and a highpressure balloon inflation is performed to fracture the surgical sewing ring of the BPV. This allows for further expansion of the BPV as well as the implanted THV, thus increasing the maximum effective orifice area that can be achieved after VIV TAVR. This review focuses on the current evidence base for BVF to facilitate VIV TAVR, including initial bench testing, procedural technique, clinical experience and future directions.
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Affiliation(s)
- John T Saxon
- Saint Luke's Mid America Heart InstituteKansas City, MO, USA.,University of Missouri - Kansas CityKansas City, MO, USA
| | - Keith B Allen
- Saint Luke's Mid America Heart InstituteKansas City, MO, USA.,University of Missouri - Kansas CityKansas City, MO, USA
| | - David J Cohen
- Saint Luke's Mid America Heart InstituteKansas City, MO, USA.,University of Missouri - Kansas CityKansas City, MO, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart InstituteKansas City, MO, USA.,University of Missouri - Kansas CityKansas City, MO, USA
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Shamim S, Magalski A, Chhatriwalla AK, Allen KB, Huber KC, Main ML. Transesophageal echocardiographic diagnosis of a WATCHMAN left atrial appendage closure device thrombus 10 years following implantation. Echocardiography 2016; 34:128-130. [DOI: 10.1111/echo.13413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/13/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shariq Shamim
- Saint Luke's Mid-America Heart Institute; Kansas City MO USA
| | | | | | - Keith B. Allen
- Saint Luke's Mid-America Heart Institute; Kansas City MO USA
| | | | - Michael L. Main
- Saint Luke's Mid-America Heart Institute; Kansas City MO USA
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47
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Allen KB, Aggarwal S, Davis JR, Laster S, Vamanan K, Borkon AM. PC004. Thoracic Endovascular Aortic Repair of the Ascending and Descending Thoracic Aorta Utilizing Left Ventricular Transapical Access. J Vasc Surg 2016. [DOI: 10.1016/j.jvs.2016.03.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McCabe JM, Huang PH, Cohen DJ, Blackstone EH, Welt FG, Davidson MJ, Kaneko T, Eng MH, Allen KB, Xu K, Lowry AM, Lei Y, Rajeswaran J, Brown DL, Mack MJ, Webb JG, Smith CR, Leon MB, Eisenhauer AC. Surgical Versus Percutaneous Femoral Access for Delivery of Large-Bore Cardiovascular Devices (from the PARTNER Trial). Am J Cardiol 2016; 117:1643-1650. [PMID: 27036077 DOI: 10.1016/j.amjcard.2016.02.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 12/20/2022]
Abstract
It is unclear if surgical exposure confers a risk advantage compared with a percutaneous approach for patients undergoing endovascular procedures requiring large-bore femoral artery access. From the randomized controlled Placement of Aortic Transcatheter Valve trials A and B and the continued access registries, a total of 1,416 patients received transfemoral transcatheter aortic valve replacement, of which 857 underwent surgical, and 559 underwent percutaneous access. Thirty-day rates of major vascular complications and quality of life scores were assessed. Propensity matching was used to adjust for unmeasured confounders. Overall, there were 116 major vascular complications (8.2%). Complication rates decreased dramatically during the study period. In unadjusted analysis, major vascular complications were significantly less common in the percutaneous access group (35 [6.3%] vs 81 [9.5%] p = 0.032). However, among 292 propensity-matched pairs, there was no difference in major vascular complications (22 [7.5%] vs 28 [9.6%], p = 0.37). Percutaneous access was associated with fewer total in-hospital vascular complications (46 [16%] vs 66 [23%], p = 0.036), shorter median procedural duration (97 interquartile range [IQR 68 to 166] vs 121 [IQR 78 to 194] minutes, p <0.0001), and median length of stay (4 [IQR 2 to 8] vs 6 [IQR 3 to 10] days, p <0.0001). There were no significant differences in quality of life scores at 30 days. Surgical access for large-bore femoral access does not appear to confer any advantages over percutaneous access and may be associated with more minor vascular complications.
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Allen KB, Borkon AM, Aggarwal S, Davis JR, Laster S, Cohen DJ, Chhatriwalla AK, Hart A, Baron SJ. The Descending Thoracic Aorta: Forgotten Vascular Access for Endovascular Device Delivery. Innovations 2016. [DOI: 10.1177/155698451601100211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Keith B. Allen
- Departments of Cardiothoracic/Vascular Surgery, Kansas City, MO USA
| | | | - Sanjeev Aggarwal
- Departments of Cardiothoracic/Vascular Surgery, Kansas City, MO USA
| | - J. Russell Davis
- Departments of Cardiothoracic/Vascular Surgery, Kansas City, MO USA
| | - Steven Laster
- Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, MO USA
| | - David J. Cohen
- Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, MO USA
| | | | - Anthony Hart
- Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, MO USA
| | - Suzanne J. Baron
- Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, MO USA
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Allen KB, Johnson LM, Borkon AM, Aggarwal S, Davis JR, Cohen DJ, Chhatriwalla AK, Grantham A, Hart A. Combined Transcatheter Aortic Valve Replacement and Thoracic Endovascular Aortic Repair Using Transapical Access. Ann Thorac Surg 2015; 100:723-7. [PMID: 26234852 DOI: 10.1016/j.athoracsur.2014.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 08/23/2014] [Accepted: 10/10/2014] [Indexed: 11/18/2022]
Abstract
Vascular complications remain an important consideration when selecting access for delivery of large endovascular devices. With the advent of transcatheter aortic valve replacement, transapical access has become an acceptable technique when transfemoral or direct transaortic access is contraindicated. We report the use of the transapical approach during thoracic aortic endovascular repair in 2 patients, one of which included concomitant delivery of a transcatheter aortic valve replacement device. To our knowledge, this is the first reported case of a hybrid single-stage transcatheter aortic valve replacement and thoracic aortic endovascular repair using transapical access.
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Affiliation(s)
- Keith B Allen
- Department of Cardiothoracic/Vascular Surgery, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri.
| | - Lesley M Johnson
- Department of Cardiothoracic/Vascular Surgery, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - A Michael Borkon
- Department of Cardiothoracic/Vascular Surgery, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - Sanjeev Aggarwal
- Department of Cardiothoracic/Vascular Surgery, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - J Russell Davis
- Department of Cardiothoracic/Vascular Surgery, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - David J Cohen
- Department of Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- Department of Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - Aaron Grantham
- Department of Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
| | - Anthony Hart
- Department of Cardiology, St. Luke's Mid America Heart & Vascular Institute, Kansas City, Missouri
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